The Trump administration is moving to penalize legal immigrants for using government benefits, including Medicaid and food assistance. Although many of the details haven't been set in stone, NPR's Joel Rose reports the idea has already ignited controversy and brought warnings about the consequences for immigrants and the nation's health care system.

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JOEL ROSE, BYLINE: In the waiting room at the Cohen Children's Medical Center on Long Island, it seems like everybody knows Omolara Uwemedimo.

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UNIDENTIFIED PERSON: For me?

OMOLARA UWEMEDIMO: How are you?

ROSE: Uwemedimo is a pediatrician at this office just outside Queens, which has a huge immigrant population.

UWEMEDIMO: This place can be extremely full. And the patients come from all different nationalities.

ROSE: Uwemedimo and her staff make a point of asking patients upfront if they qualify for benefits, including food stamps or subsidized health insurance. But now Uwemedimo is finding that many of her patients are wary about signing up because they've heard that could hurt their chances of getting a visa for a family member to visit. And one day, it could hurt their own chances of getting a green card.

UWEMEDIMO: What we've seen is that those families are now at a crossroads where they're saying, we want our families to stay together. And they have decided - a lot of families have decided that they don't want to engage in fear.

ROSE: For months, the Trump administration has been taking steps to limit how much immigrants use welfare programs. Earlier this year, the State Department told consular officials to consider denying immigrants a visa if they're expected to use certain public benefits once they get to the U.S. And the Department of Homeland Security has been working on new rules for immigrants already in the country. Those rules could prevent them from getting a green card if they sign up for benefits.

CLAUDIA CALHOON: It would penalize people for using programs that they're entitled to under the law, like health insurance for their children or making sure that there's food on the table.

ROSE: Claudia Calhoon is with the New York Immigration Coalition. She says this is setting up brutally difficult choices for immigrant families.

CALHOON: People might have to decide between doing those things and adjusting their status and having a green card.

ROSE: For at least a century, U.S. law has sought to exclude immigrants who are likely to become a, quote, "public charge." And the Trump administration says it is simply enforcing that law. More than half of all immigrant households use at least one benefit program, according to the Department of Homeland Security. DHS in a statement calls that, quote, "deeply unfair to U.S. taxpayers," unquote. NPR asked DHS secretary Kirstjen Nielsen about a leaked draft of the proposed changes in May.

KIRSTJEN NIELSEN: We cannot allow them to immigrate to the United States if we believe they will immediately become a public charge. So what we're trying to do through the rulemaking is make it clear what does that mean and get the comment from the public on what that should mean.

ROSE: The public is already weighing in. Immigrant rights activists point out that immigrants pay taxes too and that their U.S. citizen children could lose benefits under the proposal. Health care researchers at Harvard and Tufts say immigrants actually pay more into the U.S. healthcare system, including Medicare, than they take out. And doctors, including pediatrician Omolara Uwemedimo in New York, say taking away benefits would hurt their patients, especially children.

UWEMEDIMO: There's a direct link to how healthy their nutrition is, their overall growth and their brain development, especially for our young children. So if a family decides that they don't want assistance from a benefit, that has repercussions that will last throughout their life.

ROSE: Uwemedimo knows firsthand how much these benefits can matter to immigrant families. Her parents immigrated to New York from Nigeria and worked factory jobs. When her mother got pregnant, Uwemedimo says her doctor put her on bed rest, so she couldn't work.

UWEMEDIMO: She actually used food stamps when she was pregnant with me. And she says that (laughter) pretty much saved them in terms of not having to move out of their apartment because of the fact that they had that help.

ROSE: Uwemedimo says it's hard to imagine what they would have done if they had to choose between food stamps and getting their green cards. Joel Rose, NPR News, New York.

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